When you envision a speech therapy session, you often imagine a therapist sitting at a table with a child “drilling” sounds. It is not an uncommon practice for Speech Therapists to use a direct approach in therapy. This may include repetitive practice of error sounds, or cyclic question/answer interactions. It could also include structured identification of pictured items. It is true that children can successfully learn new skills through carefully designed practice. However, on the continuum of natural interactions (see box below), these trials that include prompting for a response and specific feedback related to performance are anything but natural. This is how we think about direct vs. play-based therapy.
Developmental Expectations
Think about a 6-month-old with a hearing impairment who is learning to babble. Can you imagine them participating in a structured task? Try to visualize a busy toddler sitting at a table for 30 min. Can’t do it, can you? Both of these scenarios are unrealistic expectations and not developmentally appropriate. Children, especially young children, learn through play and natural interactions within their environment. As a parent or caregiver, you probably don’t even think about the fact that just by talking to and playing with your child you are teaching them. You are, in a way, providing naturalistic intervention.
When a young child requires intervention from a Speech Therapist, naturalistic interventions may often be employed. This style of intervention involves carefully setting up the environment to provide multiple, distributed learning opportunities vs structured blocks of trials. The therapist then “follows the child’s lead”. They use the child’s interests to target selected goals. And instead of providing specific feedback related to performance, naturally occurring events provide the child with responses.
For example, if the therapist is targeting the production of single words, they may have a variety of easy to label toys in the room (e.g., ball, car, baby). When the child chooses a toy of interest, the ST will comment on the toy. They they label it, and wait for a response. They may even withhold the toy, waiting for the child to label it. Once the child does label it, the therapist will give the toy to the child for play. The child is “rewarded” for their production of the goal (a single word label) and learns that by saying the name for the toy, they are given a chance to play with it.
Determining a Technique
How do you decide between direct vs. play-based therapy? “Deciding which techniques to use for an individual child requires the professional to draw upon knowledge about normal language acquisition and to be cognizant of the needs of the particular child. A critical aspect of naturalistic interventions is the professional’s ability to read, interpret, and respond appropriately to the child’s cues.” (New York State Dept of Health).
While we are playing, we are also working to determine how to elicit a response, if the technique is appropriate for the child, and if we need to progress to a new target. This “in the moment”, ongoing assessment is work for the Speech Therapist, but all play for the child. “When play-based therapy is performed correctly, it can help the child make associations with real life events and create lasting memories needed to develop speech, language, and social skills” (Wegner, “The Importance of Play Based Therapy”).
Thank you for reading!